Systems and methods for tensioning ligaments and other soft tissues

ABSTRACT

Systems, methods and devices for tensioning posterior crucial ligaments during cruciate or bi-cruciate ligament-sparing arthroplasty. Non-limiting examples of such systems may include at least one series of tibial inserts of equal size; the at least one series of tibial inserts having at least one set of tibial inserts of equal thickness. The at least one set of tibial inserts of equal thickness may include at least two tibial inserts having different geometries in a posterior portion, the different geometries being configured to change the tension in the posterior cruciate ligament (PCL). The different geometries in the posterior portions of the tibial inserts are configured so as to allow the posterior cruciate ligament to be tensioned or loosened independently of the tibial insert thickness and/or size. By providing different posterior geometries for each insert within a set of a series, a surgeon may be provided with more flexibility in choosing an insert that satisfies stability requirements in a non-invasive manner.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/084,717, filed Apr. 12, 2011, titled “SYSTEMS AND METHODS FORTENSIONING LIGAMENTS AND OTHER SOFT TISSUES,” now allowed, which claimsthe benefit of U.S. Provisional Application Ser. No. 61/323,732, filedApr. 13, 2010 titled “SYSTEM AND METHOD FOR TENSIONING CRUCIATELIGAMENTS,” the entire contents of which are hereby incorporated byreference.

BACKGROUND

1. Related Fields

Artificial body members used in knee and other joint arthroplasty, andsystems and methods using the same, for tensioning ligaments, tendons orother soft tissues.

2. Related Art

There are currently three total knee arthroplasty (TKA) cruciateligament options available to surgeons. A first option is to sacrificeboth the posterior cruciate ligament (PCL) and the anterior cruciateligament (ACL). A second option is to retain the PCL and sacrifice theACL. A third option is to preserve both cruciate ligaments. Generally,the first and second options are more common, because most patientshaving indications for total knee arthroplasty also typically have anACL deficiency. For younger and more active patients with a healthyposterior cruciate ligament, it may be desirable in some instances toselect the second or third option and retain at least the PCL. In doingso, stability may in some cases be achieved with the patient's ownligamentous soft tissue, instead of the implant.

Referring now to FIGS. 1, 2A, and 2B, there are typically two approachesto retaining the PCL during total knee arthroplasty. To this end,surgeons may resect the entire proximal portion of the affected tibia(10) as shown in FIG. 2A, or may resect most portions of the proximaltibia, leaving only a small area (12) of protruding bone and cartilage(13, 15, 17) at the posterior portion as shown in FIGS. 1 and 2B.Because the PCL (20) has an attachment point (16) that is slightlyinferior to the resection plane (14), the PCL (20) usually staysattached to the tibia (10) regardless of which method is used. Thebenefits and disadvantages for each of the PCL-sparing resectiontechniques shown in FIGS. 2A and 2B have been widely debated. It hasbeen suggested by those in the art that the function of the PCL changeswith removal of the bone above the PCL attachment to the tibia.

Many surgeons find it difficult to leave a small area (12) of protrudingbone and cartilage (13, 15, 17) at the posterior portion of a proximaltibia (10) due to the location of the PCL and surrounding bonystructure. In fact, many surgeons prefer a total proximal resection (14)because it takes less practice and decreases operating time. Inaddition, it is generally very easy to notch the small area (12) ofremaining bone or accidentally cut it off. Therefore, the approach ofmany surgeons is to resect the entire proximal tibia (10) in the firstplace as shown in FIG. 2A.

The problem associated with the PCL-sparing technique of resecting theentire proximal tibia as shown in FIG. 2A is that it may affect laxity,stiffness, tension, and other kinematic factors of the PCL (20).Essentially, by removing the small area (12) of protruding bone andcartilage (13, 15, 17), the tension (T) in the PCL may be reduced andforces associated with the PCL may be altered. Additionally, some of theedges of the PCL (20) may be inadvertently cut along the resection plane(14), thereby increasing elasticity of the PCL due to a smallerdiameter. A loose PCL may affect anterior-posterior stability of thefemur in relationship to the tibia (10) and may defeat the purpose ofretaining the PCL in the first place.

Another problem associated with some PCL-sparing techniques involvingresecting the entire proximal tibia occurs during trial reduction.Tibial inserts of the patient's size and having different thicknessesare typically placed between the femur and tibia until the best possiblestability throughout a full range of motion is achieved. Unfortunately,an appropriately sized insert may over-stretch the PCL, or under-stretchthe PCL, leaving the surgeon to make compromises. Often, if the PCL isover-stretched or placed in too much tension after an appropriate insertthickness is selected, invasive and difficult soft tissue and ligamentreleasing is performed. Alternatively, if the PCL is too loose,under-stretched, or insufficient for stability, a deep dishcruciate-retaining insert or a posterior stabilized implant may be used.

SUMMARY

According to one embodiment of the invention, there may be provided asystem for tensioning posterior cruciate ligaments during cruciate orbi-cruciate ligament-sparing arthroplasty. The system includes at leastone series of tibial inserts of equal size; the at least one series oftibial inserts having at least one set of tibial inserts of equalthickness. The at least one set of tibial inserts of equal thickness mayinclude at least two tibial inserts having different geometries in aposterior portion, the different geometries being configured to changethe tension in the posterior cruciate ligament (PCL). The differentgeometries in the posterior portions of the tibial inserts areconfigured so as to allow the posterior cruciate ligament to betensioned or loosened independently of the tibial insert thicknessand/or size. By providing different posterior geometries for each insertwithin a set of a series, a surgeon may be provided with moreflexibility in choosing an insert that satisfies stability requirementsin a non-invasive manner.

According to one embodiment of the invention, there may be provided akit for tensioning posterior cruciate ligaments during cruciate orbi-cruciate ligament-sparing arthroplasty. The kit contains at least oneseries of tibial inserts of equal size; the at least one series oftibial inserts comprising at least one set of tibial inserts of equalthickness. The at least one set of tibial inserts of equal thickness mayinclude at least two tibial inserts having different geometries in aposterior portion, the different geometries being configured to changethe tension in the posterior cruciate ligament (PCL). The differentgeometries in the posterior portions of the tibial inserts areconfigured so as to allow the posterior cruciate ligament to betensioned or loosened independently of the tibial insert thicknessand/or size. By providing different posterior geometries for each insertwithin a set of a series, a surgeon may be provided with moreflexibility in choosing an insert that satisfies stability requirementsin a non-invasive manner.

According to another embodiment, there may be provided a method of usingsuch systems.

In some embodiments, surgeons may extract the benefit of leaving thesmall area (12) of protruding bone and cartilage (13, 15, 17), with thecomfort and ease of a full proximal tibial resection (14), noligamentous releases, and no need to change articular geometries.

In some embodiments, the surgeon is provided with the option to vary thetension in the PCL with different tibial insert options. In someembodiments, a kit allows the surgeon to vary the tension in the PCLindependently of the size and thickness of the tibial insert to achievean optimal fit, function, and stability for the patient whilesimultaneously eliminating or minimizing the need for invasive softtissue releases. Some embodiments further provide a method of using sucha system and kit.

In some embodiments, there is provided a system of components forfacilitating a knee arthroplasty procedure, the system of componentscomprising a first series of knee arthroplasty components including atleast a first knee arthroplasty component and a second knee arthroplastycomponent, wherein the first and second knee arthroplasty components areof equal size; a second series of knee arthroplasty components includingat least a third knee arthroplasty component and a fourth kneearthroplasty component, wherein the third and fourth knee arthroplastycomponents are of equal size, and wherein the first and second kneearthroplasty components are not of equal size with the third and fourthknee arthroplasty components; wherein each of the first, second, thirdand fourth knee arthroplasty components includes a wrapping surfaceconfigured for wrapping contact with a posterior cruciate ligament;wherein a geometry of the wrapping surface of the first kneearthroplasty component is different from a geometry of the wrappingsurface of the second knee arthroplasty component such that the wrappingsurface of the first knee arthroplasty component is configured togenerate at least one of a different tension in or direction of force onthe posterior cruciate ligament relative to the wrapping surface of thesecond knee arthroplasty component; and wherein a geometry of thewrapping surface of the third knee arthroplasty component is differentfrom a geometry of the wrapping surface of the fourth knee arthroplastycomponent such that the wrapping surface of the third knee arthroplastycomponent is configured to generate at least one of a different tensionin or direction of force on the posterior cruciate ligament relative tothe wrapping surface of the fourth knee arthroplasty component.

In some embodiments, the first knee arthroplasty component has anoverall thickness that is the same as the second knee arthroplastycomponent and the third knee arthroplasty component has an overallthickness that is the same as the fourth knee arthroplasty component.

In some embodiments, the first series further comprises a fifth kneearthroplasty component, wherein the fifth knee arthroplasty componenthas an overall thickness that is different from the overall thickness ofthe first and second knee arthroplasty components; and the second seriesfurther comprises a sixth knee arthroplasty component, wherein the sixthknee arthroplasty component has an overall thickness that is differentfrom the overall thickness of the third and fourth knee arthroplastycomponents.

In some embodiments, the first, second, third and fourth kneearthroplasty components are tibial components and the wrapping surfacesare notches formed in posterior edges of the knee arthroplastycomponents.

In some embodiments, the notches are centrally located between medialand lateral condylar articulating surfaces.

In some embodiments, the tibial components are tibial inserts.

In some embodiments, the tibial inserts are tibial trials.

In some embodiments, the tibial inserts are cruciate sparing tibialinserts.

In some embodiments, each of the knee arthroplasty components include ananterior-posterior axis and the wrapping surface of the first kneearthroplasty component is positioned further posteriorily along theanterior-posterior axis of the first knee arthroplasty componentrelative to the wrapping surface of the second knee arthroplastycomponent.

In some embodiments, each of the knee arthroplasty components include ananterior-posterior axis and the wrapping surface of the first kneearthroplasty component is oriented at a different angle to theanterior-posterior axis of the first knee arthroplasty componentrelative to the wrapping surface of the second knee arthroplastycomponent.

In some embodiments, the first knee arthroplasty component is positionedfurther posteriorily along the anterior-posterior axis of the first kneearthroplasty component relative to the wrapping surface of the secondknee arthroplasty component.

In some embodiments, the wrapping surfaces are bowed inwardly.

In some embodiments, the wrapping surface of the first knee arthroplastycomponent extends further superiorly relative to the wrapping surface ofthe second knee arthroplasty component.

In some embodiments, the knee arthroplasty components include ananterior-posterior axis and the wrapping surface of the first kneearthroplasty component is positioned further posteriorily along theanterior-posterior axis of the first knee arthroplasty componentrelative to the wrapping surface of the second knee arthroplastycomponent; and the wrapping surface of the first knee arthroplastycomponent extends further superiorly relative to the wrapping surface ofthe second knee arthroplasty component.

In some embodiments, the first and second series of knee arthroplastycomponents are part of a kit of knee arthroplasty components.

In some embodiments, there is provided a system of components forfacilitating a knee arthroplasty procedure, the system of componentscomprising: a first series of knee arthroplasty components including atleast a first knee arthroplasty component and a second knee arthroplastycomponent, wherein the first and second knee arthroplasty components areof equal size; a second series of knee arthroplasty components includingat least a third knee arthroplasty component and a fourth kneearthroplasty component, wherein the third and fourth knee arthroplastycomponents are of equal size, and wherein the first and second kneearthroplasty components are not of equal size with the third and fourthknee arthroplasty components; wherein each of the first, second, thirdand fourth knee arthroplasty components includes a wrapping surfaceconfigured for wrapping contact with a posterior cruciate ligament;wherein a geometry of the wrapping surface of the first kneearthroplasty component is different from a geometry of the wrappingsurface of the second knee arthroplasty component such that the wrappingsurface of the first knee arthroplasty component is configured togenerate at least one of a different tension in or direction of force onthe posterior cruciate ligament relative to the wrapping surface of thesecond knee arthroplasty component; wherein a geometry of the wrappingsurface of the third knee arthroplasty component is different from ageometry of the wrapping surface of the fourth knee arthroplastycomponent such that the wrapping surface of the third knee arthroplastycomponent is configured to generate at least one of a different tensionin or direction of force on the posterior cruciate ligament relative tothe wrapping surface of the fourth knee arthroplasty component; whereinthe first knee arthroplasty component has an overall thickness that isthe same as the second knee arthroplasty component and the third kneearthroplasty component has an overall thickness that is the same as thefourth knee arthroplasty component; and wherein the first, second, thirdand fourth knee arthroplasty components are tibial components and thewrapping surfaces are formed proximate posterior edges of the kneearthroplasty components.

In some embodiments, there is provided a method for performing a jointarthroplasty procedure on a joint, comprising: determining a desiredsize for an implant for the joint; positioning a first implant of thedesired size relative to the joint such that a soft tissue associatedwith the joint is in wrapping contact with a first wrapping surface ofthe first implant; assessing the joint while the first implant ispositioned relative to the joint and the soft tissue is in wrappingcontact with the first wrapping surface; positioning a second wrappingsurface in wrapping contact with the soft tissue; assessing the jointwhile the soft tissue is in wrapping contact with the second wrappingsurface; and implanting a final joint implant in the joint.

In some embodiments, positioning the second wrapping surface in wrappingcontact with the soft tissue comprises positioning a second implant ofthe same desired size relative to the joint such that the soft tissueassociated with the joint is in wrapping contact with the secondwrapping surface of the second implant.

In some embodiments, positioning the first implant comprises positioningthe first implant such that a posterior cruciate ligament is in wrappingcontact with a notch in a posterior edge of a first tibial implant suchthat the posterior cruciate ligament is tensioned at a first tension orsubjected to a first force direction.

In some embodiments, positioning the second implant comprisespositioning the second implant such that the posterior cruciate ligamentis in wrapping contact with a notch in a posterior edge of a secondtibial implant such that the posterior cruciate ligament is tensioned ata different tension or subjected to a different force direction.

In some embodiments, positioning the second wrapping surface in wrappingcontact with the soft tissue comprises adjusting or modifying the firstimplant.

In some embodiments, there is provided a kit of joint arthroplastycomponents, comprising: a plurality of size series of components, eachsize series of components comprising a plurality of components of equalsize in a transverse plane; wherein each size series of componentsfurther comprises a plurality of thickness sets of components, eachthickness set of components comprising a plurality of components ofequal thickness in a sagittal plane; and wherein each thickness set ofcomponents further comprises a plurality of soft tissue accommodationcomponents, wherein each soft tissue accommodation component comprises adifferent soft tissue accommodation geometry.

In some embodiments, each thickness set of components comprises aplurality of components having the same articular configuration.

Further areas of applicability of the invention will become apparentfrom the detailed description provided hereinafter. It should beunderstood that the detailed description and specific examples, whileindicating certain embodiments of the invention, are intended forpurposes of illustration only and are not intended to limit the scope ofthe invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and form a part ofthe specification, illustrate the embodiments of the invention andtogether with the written description serve to explain the principles,characteristics, and features of the invention. In the drawings:

FIG. 1 is a posterolateral view of a proximal tibia after a firstconventional PCL-sparing resection.

FIG. 2A is a side (sagittal) schematic representation of a proximaltibia after a second conventional PCL-sparing resection.

FIG. 2B is a side (sagittal) schematic representation of the firstconventional PCL-sparing resection shown in FIG. 1.

FIG. 3 is a posterolateral view of a proximal tibia incorporating oneembodiment of a tibial insert.

FIGS. 4A-4C. are top (superior) views of tibial inserts according toanother embodiment.

FIG. 5 illustrates a top (superior) view of a system according to someembodiments.

FIG. 6. illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments.

FIG. 7. illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments.

FIG. 8. illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments.

FIG. 9. illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments.

FIG. 10. illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments.

FIG. 11. illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments.

FIG. 12. illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments.

FIG. 13. illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments.

FIG. 14. illustrates a side (sagittal) view of a set of tibial insertsaccording to some embodiments of the present invention.

FIG. 15. illustrates a side (sagittal) view of a set of tibial insertsaccording to some embodiments.

FIG. 16. illustrates a side (sagittal) view of a set of tibial insertsaccording to some embodiments.

FIG. 17. illustrates a side (sagittal) view of a set of tibial insertsaccording to some embodiments.

FIG. 18. illustrates a method of using a system according to someembodiments.

FIGS. 19A and 19B schematically illustrate a proximal tibia after a PCLsparing resection and tibial inserts positioned thereon according tosome embodiments.

DETAILED DESCRIPTION OF THE DRAWINGS

The following description of the drawings is merely exemplary in natureand is in no way intended to limit the invention, its application, oruses.

As discussed above, certain embodiments of the invention provide, inpart, an orthopaedic system that facilitates a surgeon adjusting PCLtension independently of other tibial sizes, shapes, thickness, andother features. Such embodiments may further provide, in part, tibialinserts that use posterior geometry changes that can change the tensionin a posterior-cruciate ligament and/or change the direction of theforces generated by or acting on the PCL to match an individualpatient's needs or to optimize the performance of a given prosthesis. Byselecting a tibial insert that has the most appropriate surface for thePCL to articulate with, independently of other tibial insert featuresand configurations, a surgeon is armed with more intraoperative optionswithout the need for invasive soft tissue releases or other compromises.

In some, although not necessarily all, embodiments, it may be preferredthat proper sizing and trial reduction be performed prior to utilizingthe PCL-tension-adjusting tibial inserts of the invention; however, themethod steps disclosed herein may be practiced in any order, alone, orin combination with other method steps.

The usefulness of the present invention is not limited to tibialinserts, but may also, for instance and without limitation, have similarapplicability with femoral components in a similar manner as would beappreciated by those of ordinary skill in the art. For instance, similargeometry changes on a femoral component adjacent the femoral PCLattachment location may serve to adjust tension in the PCL as well aschange the direction of the forces exerted on and by the PCL. Suchgeometry changes can be implemented by an integrally-formed shape, or, aseparate add-on device that is fixed to the femoral component and whichmay be adjustable to “tune” the tension in the PCL and/or the directionof the forces generated by or acting on the PCL. In still otherembodiments, the concepts, structures, systems and methods of theembodiments described herein may be applied to other ligaments, tendonsor other soft tissues of the knee or other joints connected by such softtissues.

As previously stated above, FIGS. 1, 2A, and 2B illustrate conventionalapproaches to retaining the PCL during total knee arthroplasty. To thisend, surgeons have the option to resect the entire proximal portion ofthe affected tibia (10) as shown in FIG. 2A or may resect most portionsof the proximal tibia, leaving only a small area (12) of protruding boneand cartilage (13, 15, 17) at the posterior portion as shown in FIGS. 1and 2B. Because the PCL (20) has an attachment point (16) that isslightly inferior to the resection plane (14), the PCL (20) staysattached to the tibia (10) regardless of which method is used.

FIG. 3 illustrates a posterolateral view of a proximal tibia (10)incorporating a tibial insert (30) according to some embodiments. Theinsert (30) includes a mechanism for tensioning a PCL (32), which, inthis particular embodiment, is a removable pin. Other tensioningmechanisms may be removably attached or integrally-formed with aposterior (44) portion of the tibial insert (30). Such tensioningmechanisms (32) may be an adjustable tensioning device such as aturnbuckle, cam, jack mechanism, tensioning pin, or may simply comprisea series of interchangeable dowels having different cross-sectionalgeometries, sizes, cam surfaces, and/or shapes, and which can beselectively swapped out of the tibial insert (30). In the embodimentshown in FIG. 3, there is a holder (36,38) for holding the PCLtensioning mechanism (32), at least temporarily securing it to theinsert (30). In other embodiments, other holding mechanisms may include,without limitation, any one or more of a hole, channel, track, groove,pocket, snap-fit mechanism (e.g., plastic barb or ball detent),press-fit, or other conventional or non-conventional devices as will beappreciated by those of ordinary skill in the art.

In the embodiment shown in FIG. 3, the tensioning mechanism (32) is awrapping surface configured for wrapping contact with the PCL. In someembodiments, it may be desirable for the wrapping surface to be apolished or otherwise smooth surface, since the PCL will be partiallywrapped around it and may articulate and/or experience other motions ormicro-motions with respect to the wrapping surface. In some embodiments,the wrapping surface may be poly-ethylene, metal, ceramic, oxidizedzirconium, cobalt chrome, or another material or other treatments ofmaterials.

FIGS. 4A-4C illustrate a set of tibial inserts according to someembodiments. The set of tibial inserts (130) each have a similar sizeand thickness with the exception that a posterior geometry changesbetween the tibial inserts (130) in order to change the tension in thePCL. The change in geometry for the embodiment shown in FIGS. 4A-4Ccomprises a posterior wall (132 a, 132 b, 132 c) that is generallyperpendicular to the anterior-posterior axis and is generally located atdifferent positions along the anterior-posterior axis for differenttibial inserts (130) in the set. FIG. 4A illustrates a posterior wall(132 a) that is positioned more anteriorly than either of the posteriorwalls (132 b, 132 c) found in FIGS. 4B or 4C. The insert (130) shown inFIG. 4C generally places a higher tension in the PCL than the inserts(130) shown in FIGS. 4A and 4B. The insert (130) shown in FIG. 4Agenerally places a lower tension in the PCL than the inserts (130) shownin FIGS. 4B and 4C. In this particular embodiment, portions of theseposterior walls are wrapping surfaces/tensioning mechanisms.

FIG. 5 illustrates a top (superior) view of a system (200) according tosome embodiments. The system (200) includes three series (210,220,230)of tibial inserts of equal size. In other embodiments, other numbers ofseries may be present. Each of the one or more series (210,220,230)shown in FIG. 5 includes three sets (212,214,216; 222,224,226;232,234,236) (which may also vary in number) of tibial inserts havingthe same thickness and/or articular configuration (e.g., deep-dish).Each of the one or more sets (212,214,216; 222,224,226; 232,234,236)shown in FIG. 5 includes three tibial inserts (which may also vary innumber) having different posterior geometries, the different posteriorgeometries being adapted and configured to change at least one of orboth the tension in the PCL and a direction of force exerted on or bythe PCL (e.g. act as tensioning mechanisms/wrapping surfaces).

For example, without limitation, an orthopaedic system (200) may includea series (210) of size “X” tibial inserts. The patient is measuredintra-operatively and is deemed to be a candidate for a size “X” tibialinsert. The surgeon selects the size “X” series (210) of tibial insertsand begins trial reduction to optimize flexion gap. In order to do this,the surgeon selects one standard insert from each set (212,214,216) ofinserts within the series (210). The surgeon selects the set(212,214,216) of inserts that provides the best general stability andflexion gap throughout full or partial range of motion. For instance, ifset (214) yields the best stability for the size “X” patient andprovides the optimum thickness for a tibial insert for the patient, thenthe surgeon begins a second trial reduction for PCL tension andstability using the set (214) of tibial inserts. Next, the surgeonassesses the tightness or laxity of the PCL throughout a range of motionand selects a tibial insert (214 a, 214 b, 214 c) within the set (214)of tibial inserts that provides the best tension, stability, and/orpositioning of the PCL for optimum stability when using a size “X”series (210) tibial insert having a thickness as defined by set (214),without the need for release of the PCL or surrounding soft orligamentous tissue.

FIG. 6 illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments. A first tibial insert (312) in the setincludes a first posterior geometry that comprises a first posteriorwall (313) at a first specified location along the anterior-posterioraxis. A second tibial insert (314) in the set includes a secondposterior geometry that comprises a second posterior wall (315) at asecond specified location along the anterior-posterior axis which ismore posterior than the first specified location. A third tibial insert(316) in the set includes a third posterior geometry that comprises athird posterior wall (317) at a third specified location along theanterior-posterior axis which is more posterior than both of the firstand second specified locations. The first, second, and third posteriorwalls (313,315,317) are each positioned at different angles relative tothe anterior-posterior axis. This allows the direction of imparted andreaction forces associated with the PCL to be changed between inserts,independently of the size, thickness, and articular configuration of theinserts (312,314,316). It also allows the PCL to be tensioned indifferent amounts between inserts, independently of the size, thickness,and articular configuration of the inserts (312,314,316).

FIG. 7 illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments. A first tibial insert (322) in the setincludes a first posterior geometry that comprises a first posteriorwall (323) at a first specified location along the anterior-posterioraxis. A second tibial insert (324) in the set includes a secondposterior geometry that comprises a second posterior wall (325) at asecond specified location along the anterior-posterior axis which ismore posterior than the first specified location. A third tibial insert(326) in the set includes a third posterior geometry that comprises athird posterior wall (327) at a third specified location along theanterior-posterior axis which is more posterior than both of the firstand second specified locations. The first, second, and third posteriorwalls (323,325,327) are each positioned at the same angle relative tothe anterior-posterior axis. This allows the PCL to be tensioned indifferent amounts between inserts, independently of the size, thickness,and articular configuration of the inserts (322,324,326), while stillmaintaining the direction of all imparted and reaction forces associatedwith the PCL.

FIG. 8 illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments. A first tibial insert (332) in the setincludes a first posterior geometry that comprises a first posteriorwall (333) at a first specified location along the anterior-posterioraxis. A second tibial insert (334) in the set includes a secondposterior geometry that comprises a second posterior wall (335) at asecond specified location along the anterior-posterior axis which ismore posterior than the first specified location. A third tibial insert(336) in the set includes a third posterior geometry that comprises athird posterior wall (337) at a third specified location along theanterior-posterior axis which is more posterior than both of the firstand second specified locations. The first, second, and third posteriorwalls (333,335,337) are each positioned at the same angle relative tothe anterior-posterior axis, and are each generally positionedorthogonal to the anterior-posterior axis. This allows the PCL to betensioned in different amounts between inserts, independently of thesize, thickness, and articular configuration of the inserts(332,334,336), while still maintaining the direction of all imparted andreaction forces associated with the PCL.

FIG. 9 illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments. Similar to FIG. 6, FIG. 9 shows a firsttibial insert (342) in the set that includes a first posterior geometryhaving a first posterior wall (343) at a first specified location alongthe anterior-posterior axis. A second tibial insert (344) in the setincludes a second posterior geometry that comprises a second posteriorwall (345) at a second specified location along the anterior-posterioraxis which is more posterior than the first specified location. A thirdtibial insert (346) in the set includes a third posterior geometry thatcomprises a third posterior wall (347) at a third specified locationalong the anterior-posterior axis which is more posterior than both ofthe first and second specified locations. The first, second, and thirdposterior walls (343,345,347) are each positioned at different anglesrelative to the anterior-posterior axis. This allows the direction ofall imparted and reaction forces associated with the PCL to be changedbetween inserts, independently of the size, thickness, and articularconfiguration of the inserts (342,344,346). It also allows the PCL to betensioned in different amounts between inserts, independently of thesize, thickness, and articular configuration of the inserts(342,344,346).

Because the first, second and third posterior walls (343,345,347) areangled to change the direction of imparted and reaction forcesassociated with the PCL, as well as the PCL tension, the walls(343,345,347) may be bowed or be provided with a concavity in order tokeep the PCL centered within the posterior walls (343,345,347), and/orto keep the PCL from sliding medially or laterally out of the vicinityof the posterior walls (343,345,347).

FIG. 10 illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments. A first tibial insert (352) in the setincludes a first posterior geometry including a first posterior wall(353) at a first specified location along the anterior-posterior axis. Asecond tibial insert (354) in the set includes a second posteriorgeometry including a second posterior wall (355) at a second specifiedlocation along the anterior-posterior axis, which is more posterior thanthe first specified location. A third tibial insert (356) in the setincludes a third posterior geometry having a third posterior wall (357)at a third specified location along the anterior-posterior axis, whichis more posterior than both of the first and second specified locations.The first, second, and third posterior walls (353,355,357) are eachpositioned at the same angle relative to the anterior-posterior axis.This allows the PCL to be tensioned in different amounts betweeninserts, independently of the size, thickness, and articularconfiguration of the inserts (352,354,356), while still maintaining thedirection of imparted and reaction forces associated with the PCL.

Because the first, second and third posterior walls (353,355,357) areangled, the walls (353,355,357) may be bowed or be provided with aconcavity in order to keep the PCL centered within the posterior walls(353,355,357), and/or to keep the PCL from sliding medially or laterallyout of the vicinity of the posterior walls (353,355,357).

FIG. 11 illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments. A first tibial insert (362) in the setincludes a first posterior geometry having a first posterior wall (363)at a first specified location along the anterior-posterior axis. Asecond tibial insert (364) in the set includes a second posteriorgeometry having a second posterior wall (365) at a second specifiedlocation along the anterior-posterior axis which is more posterior thanthe first specified location. A third tibial insert (366) in the setincludes a third posterior geometry having a third posterior wall (367)at a third specified location along the anterior-posterior axis, whichis more posterior than both of the first and second specified locations.The first, second, and third posterior walls (363,365,367) are eachpositioned at the same angle relative to the anterior-posterior axis andare each generally positioned orthogonal to the anterior-posterior axis.This allows the PCL to be tensioned in different amounts betweeninserts, independently of the size, thickness, and articularconfiguration of the inserts (362,364,366), while still maintaining thedirection of imparted and reaction forces associated with the PCL. Inorder to keep the PCL centered within the posterior walls (363,365,367)and/or to keep the PCL from sliding medially or laterally out of thevicinity of the posterior walls (363,365,367), the first, second andthird posterior walls (363,365,367) may be bowed or be provided with aconcavity as illustrated.

FIG. 12 illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments. FIG. 12 is similar to FIG. 9, in that theangle of the posterior walls (373,375,377) changes to change thedirection of imparted and reaction forces associated with the PCLbetween inserts, independently of the size, thickness, and articularconfiguration of the inserts (372,374,376). However, the centroid ofposterior walls (373,375,377) of the tibial inserts (372,374,376) shownin FIG. 12 do not move posteriorly between inserts. In doing so, whilethe direction of imparted and reaction forces associated with the PCLchanges between inserts, independently of the size, thickness, andarticular configuration of the inserts (372,374,376), the tension in thePCL does not necessarily change between inserts, or at least change toas great of an extent as if the centroid of the posterior wall was movedanterior or posterior.

Because the first, second and third posterior walls (373,375,377) areangled, the walls (373,375,377) may be bowed or be provided with aconcavity as shown, in order to keep the PCL centered within theposterior walls (373,375,377), and/or to keep the PCL from slidingmedially or laterally out of the vicinity of the posterior walls(373,375,377).

FIG. 13. illustrates a top (superior) view of a set of tibial insertsaccording to some embodiments. FIG. 13 essentially illustrates a similarembodiment to the one shown in FIG. 12, but having posterior walls(383,385,387) with more extreme angle inclinations and no concavities.

FIG. 14. illustrates a side (sagittal) view of a set of tibial insertsaccording to some embodiments. A set of tibial inserts (400,402,404,406)is provided, each insert comprising a posterior wall (401,403,405,407,respectively) that is located in a different position along ananterior-posterior axis. By shifting the posterior walls(401,403,405,407) in a posterior direction, tension within a preservedPCL can be increased independently of the size, thickness, and/orarticular configuration of the inserts (400,402,404,406).

While FIGS. 3-14 show embodiments utilizing geometry changes within atransverse plane to tension in the PCL and/or change direction of forcesimparted by and acting on the PCL, FIGS. 14-16 illustrate how tensionsand force directions associated with the PCL may be changed by utilizinggeometry changes in a sagittal plane as well. FIG. 17 illustrates howtensions and force directions associated with the PCL may be changed byutilizing geometry changes in both transverse and sagittal planes. Oneof ordinary skill in the art may appreciate that complexthree-dimensional surfaces in all dimensions and planes (transverse,sagittal, and coronal) may be envisaged from the disclosure of thisspecification. FEA testing may be advantageously utilized with advancedprograms, such as LifeMOD or KneeSIM, to develop an ideal or optimizedshape for the PCL-tensioning means disclosed herein. LifeMOD and KneeSIMare trademarks of LifeModeler, Inc., 2730 Camino Capistrano, Suite 7,San Clemente, Calif.

FIG. 15 illustrates a side (sagittal) view of a set of tibial insertsaccording to some embodiments. A set of tibial inserts (410,412,414,416)is provided, each insert comprising a posterior wall geometry(411,413,415,417, respectively) which is located in a different positionalong an anterior-posterior axis. By shifting the posterior walls(411,413,415,417) more posteriorly as well as superiorly, tension withina preserved PCL can be increased independently of the size, thickness,and/or articular configuration of the inserts (410,412,414,416).

FIG. 16 illustrates a side (sagittal) view of a set of tibial insertsaccording to some embodiments. A set of tibial inserts (420,422,424,426)is provided, each insert comprising a posterior wall geometry(421,423,425,427, respectively) that is located in the same positionrelative along an anterior-posterior axis. By shifting the posteriorwalls (421,423,425,427) more superiorly, tension within a preserved PCLcan be increased independently of the size, thickness, and/or articularconfiguration of the inserts (420,422,424,426).

FIG. 17 illustrates a side (sagittal) view of a set of tibial insertsaccording to some embodiments. A set of tibial inserts (430,432,434,436)is provided, each insert comprising a posterior wall geometry(431,433,435,437, respectively) that is located in the same positionrelative along an anterior-posterior axis. By shifting the posteriorwalls (431,433,435,437) purely posteriorly, posteriorly and superiorly,purely superiorly and various combinations thereof, tension within apreserved PCL can be increased independently of the size, thickness,and/or articular configuration of the inserts (430,432,434,436).

FIG. 18. is a schematic flowchart illustrating a method of using asystem according to some embodiments. First, the entire proximal tibiais resected (502). The knee is then sized as conventionally done (504).Femoral and tibial tray implantation (506) is then performed. Step (506)may not be required for hemi-arthroplasty cases or for proceduresutilizing cemented tibial inserts that do not use conventional tibialtrays. Next, trial reductions are performed using a series ofcorrectly-sized tibial inserts (508). Trial reduction may include a fullrange of motion assessment, drawer test, etc. After a desired tibialinsert thickness is selected (510), the surgeon assesses theposterior-cruciate ligament for proper tensioning and function (512). Ifthe prosthesis performs well, the surgeon may finish surgery in aconventional manner (520). If the PCL is too loose, the surgeon may tryanother insert having the same thickness and size with the exception ofa greater or more “proud” posterior geometry to stretch and tighten thePCL as shown in step (516). Alternatively, if the PCL is too tight, thesurgeon may try another insert having the same thickness and size withthe exception of a smaller or less “proud” posterior geometry to loosenthe PCL as shown in step (518). In addition to steps (514),(516), and(518), the surgeon may select other tibial insert options which changethe angle, position in space, or location of the PCL independently or incombination with the steps of adjusting tension (step not illustrated).

FIGS. 19A and 19B schematically illustrate a proximal tibia (100) aftera PCL sparing resection and tibial inserts (600, 602) positioned thereonaccording to some embodiments. As schematically illustrated by theseFigures, the different posterior wall geometries (601, 603) of the twoinserts (600, 602) interact differently with the PCL (20). For instance,the posterior wall geometry (601) of FIG. 19A allows the PCL (20) toextend in a relatively straight line between its tibial attachment pointand its attachment point on the distal femur (not shown). Conversely,the posterior wall geometry (603) of FIG. 19B forces the PCL (20) towrap about it to a greater extent. Accordingly, the PCL (20) is morecurved when positioned with respect to the insert (602) of FIG. 19B, andwould likely be tensioned to a greater extent.

Alternative embodiments may include various mechanisms for adjusting PCLtension comprising geometries for optimizing PCL function, geometriesfor controlling the medial-lateral position of the PCL, geometries forcontrolling the height of the PCL relative to a surface of the tibialinsert, geometries for changing or controlling the angle of the PCLrelative to a surface of the tibial insert as viewed in the sagittalplane, geometries for changing or controlling the angle of the PCLrelative to a surface of the tibial insert as viewed in a transverseplane along the superior-inferior axis, geometries for controlling theinternal-external rotation of the PCL relative to a surface of thetibial insert, geometries for controlling the convexity or concavity ofthe surface and to reduce sliding of the PCL within a transverse plane,and other geometries without limitation. At least some embodiments ofthe invention also may be advantageously utilized with other surgicalprocedures requiring soft tissue balancing or release after bone cutshave been made or procedures which might involve soft tissues coming incontact with an orthopaedic implant or prosthesis. The shapes,geometries, and configurations included in this disclosure may furthercomprise surface treatments to optimize frictional and biologicalinteractions between the means for PCL tensioning and the PCL or othersurrounding soft-tissues. Such surface treatments may include withoutlimitation, material surface treatments (e.g., metallurgical,ceramic-based, and/or polymeric surface treatments such as selectivecross-linking) or additive surface treatments (e.g., antioxidants,antimicrobial/anti-infection, and pain management additives). The meansfor tensioning the PCL as described herein may be comprised of amaterial dissimilar to the material of the tibial insert.

In some instances, such as for bi-cruciate retaining prostheses, it maybe desirable to adjust tension in the ACL alone, or in combination withtensioning the PCL. Therefore, while mechanisms for tensioning the PCLhas been disclosed in greater detail in this specification, similarmechanisms for tensioning a preserved ACL may be equally-employed on amiddle or anterior portion of a tibial insert in a similar fashion, inorder to adjust tension in the ACL as well as PCL. ACL tensioningmechanisms (if provided) may be adapted to work in combination with, orindependently of PCL tensioning.

As various modifications could be made to the exemplary embodiments, asdescribed above with reference to the corresponding illustrations,without departing from the scope of the invention, it is intended thatall matter contained in the foregoing description and shown in theaccompanying drawings shall be interpreted as illustrative rather thanlimiting. Thus, the breadth and scope of the present invention shouldnot be limited by any of the above-described exemplary embodiments.

1. (canceled)
 2. A system of components for facilitating a kneearthroplasty procedure, the system of components comprising: (a) a firstseries of knee arthroplasty components including at least a first kneearthroplasty component and a second knee arthroplasty component, whereinthe first and second knee arthroplasty components are of equal size; (b)a second series of knee arthroplasty components including at least athird knee arthroplasty component and a fourth knee arthroplastycomponent, wherein the third and fourth knee arthroplasty components areof equal size, and wherein the first and second knee arthroplastycomponents are not of equal size with the third and fourth kneearthroplasty components; (c) wherein each of the first, second, thirdand fourth knee arthroplasty components includes a wrapping surfaceconfigured for wrapping contact with a posterior cruciate ligament; (d)wherein a geometry of the wrapping surface of the first kneearthroplasty component is different from a geometry of the wrappingsurface of the second knee arthroplasty component such that the wrappingsurface of the first knee arthroplasty component is configured togenerate at least one of a different tension in or direction of force onthe posterior cruciate ligament relative to the wrapping surface of thesecond knee arthroplasty component; (e) wherein a geometry of thewrapping surface of the third knee arthroplasty component is differentfrom a geometry of the wrapping surface of the fourth knee arthroplastycomponent such that the wrapping surface of the third knee arthroplastycomponent is configured to generate at least one of a different tensionin or direction of force on the posterior cruciate ligament relative tothe wrapping surface of the fourth knee arthroplasty component; (f)wherein the first knee arthroplasty component has an overall thicknessthat is the same as the second knee arthroplasty component and the thirdknee arthroplasty component has an overall thickness that is the same asthe fourth knee arthroplasty component; (g) wherein the first, second,third and fourth knee arthroplasty components are tibial components andthe wrapping surfaces are notches formed in posterior edges of the kneearthroplasty components, the notches being centrally located betweenmedial and lateral condylar articulating surfaces; and (h) wherein eachof the knee arthroplasty components include an anterior-posterior axisand wherein the wrapping surface of the first knee arthroplastycomponent is oriented at a different angle to the anterior-posterioraxis of the first knee arthroplasty component relative to the wrappingsurface of the second knee arthroplasty component
 3. The system of claim2, wherein: (a) the first series further comprises a fifth kneearthroplasty component, wherein the fifth knee arthroplasty componenthas an overall thickness that is different from the overall thickness ofthe first and second knee arthroplasty components; and (b) the secondseries further comprises a sixth knee arthroplasty component, whereinthe sixth knee arthroplasty component has an overall thickness that isdifferent from the overall thickness of the third and fourth kneearthroplasty components.
 4. The system of claim 2, wherein the tibialcomponents are tibial inserts.
 5. The system of claim 4, wherein thetibial inserts are tibial trials.
 6. The system of claim 4, wherein thetibial inserts are cruciate sparing tibial inserts.
 7. The system ofclaim 2, wherein the first knee arthroplasty component is positionedfurther posteriorily along the anterior-posterior axis of the first kneearthroplasty component relative to the wrapping surface of the secondknee arthroplasty component.
 8. The system of claim 7, wherein thewrapping surfaces are bowed inwardly.
 9. The system of claim 2, whereinthe first and second series of knee arthroplasty components are part ofa kit of knee arthroplasty components.
 10. A method for performing ajoint arthroplasty procedure on a joint, comprising: (a) determining adesired size for an implant for the joint; (b) positioning a firstimplant of the desired size relative to the joint such that a softtissue associated with the joint is in wrapping contact with a firstwrapping surface of the first implant; (c) assessing the joint while thefirst implant is positioned relative to the joint and the soft tissue isin wrapping contact with the first wrapping surface; (d) positioning asecond wrapping surface in wrapping contact with the soft tissue; (e)assessing the joint while the soft tissue is in wrapping contact withthe second wrapping surface; and (f) implanting a final joint implant inthe joint.
 11. The method of claim 10, wherein positioning the secondwrapping surface in wrapping contact with the soft tissue comprisespositioning a second implant of the same desired size relative to thejoint such that the soft tissue associated with the joint is in wrappingcontact with the second wrapping surface of the second implant.
 12. Themethod of claim 11, wherein positioning the first implant comprisespositioning the first implant such that a posterior cruciate ligament isin wrapping contact with a notch in a posterior edge of a first tibialimplant such that the posterior cruciate ligament is tensioned at afirst tension or subjected to a first force direction.
 13. The method ofclaim 12, wherein positioning the second implant comprises positioningthe second implant such that the posterior cruciate ligament is inwrapping contact with a notch in a posterior edge of a second tibialimplant such that the posterior cruciate ligament is tensioned at adifferent tension or subjected to a different force direction.
 14. Themethod of claim 10, wherein positioning the second wrapping surface inwrapping contact with the soft tissue comprises adjusting or modifyingthe first implant.
 15. A kit of joint arthroplasty components,comprising: (a) a plurality of size series of components, each sizeseries of components comprising a plurality of components of equal sizein a transverse plane; (b) wherein each size series of componentsfurther comprises a plurality of thickness sets of components, eachthickness set of components comprising a plurality of components ofequal thickness in a sagittal plane; and (c) wherein each thickness setof components further comprises a plurality of soft tissue accommodationcomponents, wherein each soft tissue accommodation component comprises adifferent soft tissue accommodation geometry.
 16. The kit of claim 15,wherein each thickness set of components comprises a plurality ofcomponents having the same articular configuration.
 17. A tibial trialcomponent kit, comprising: a first tibial trial component includingmedial and lateral condylar articulating surfaces and a mid-regionconnecting the medial and lateral surfaces, the mid-region having aposterior cut-out for receiving the posterior cruciate ligament of apatient in use; a second tibial trial component including medial andlateral condylar articulating surfaces and a mid-region connecting themedial and lateral surfaces, the mid-region of the second tibial trialcomponent having a posterior cut-out for receiving the posteriorcruciate ligament of a patient in use; wherein the first and secondtibial trial component cut-outs differ in posterior geometry along ananterior-posterior axis such that switching between the tibial trialcomponents changes the tension in the posterior cruciate ligament. 18.The tibial trial component kit of claim 17, wherein the kit furthercomprises tibial trial components that vary in size.
 19. The tibialtrial component kit of claim 18 wherein the kit further comprises tibialtrial components that vary in thickness.
 20. The tibial trial componentkit of claim 17 wherein the kit further comprises tibial trialcomponents that vary in thickness.
 21. A method of changing the tensionin the posterior cruciate ligament during total knee arthroplasty,comprising: coupling a first tibial trial component to a resected tibialsurface, a posterior cut-out of the first tibial trial componentreceiving the posterior cruciate ligament of the patient such that theposterior cruciate ligament is placed under a first tension; removingthe first tibial trial component; and coupling a second tibial trialcomponent to the resected tibial surface, a posterior cut-out of thesecond tibial trial component receiving the posterior cruciate ligamentof the patient, the posterior geometry of the cut-out of the secondtibial trial component being different from that of the first tibialtrial component along an anterior-posterior axis such that the posteriorcruciate ligament is placed under a different tension from the firsttension.